minnesota - mnaappediatric cardiology 2014 review course the ritz-carlton, calif thurs, sept. 11 -...

1MNAAP -- Dedicated to the health of all children. Visit us at www.mnaap.org

MinnesotaPediatrician

www.mnaap.org

The NewsleT Ter for The MiNNesoTa ChaPTer of The aMeriCaN aCadeMy of PediaTriCs

Local CMEs 2

Pediatricians’ Day at 3 the Capitol March 26

Hot Topics in 4-5 Pediatrics Conference June 13

Word from the 6-7 President

Newborn Screening 8 continued

Persistent Disparities 9

Screen Time in 10-11 Moderation

Member Profile: 12 Janice Rourk, MD

Membership Info 13

CHIPRA Project 14 Update

Health Care Home 15 Project Update

February 2014

By Anne Edwards, MD, FAAP, chair of MNAAP’s Policy Committee

MNAAP Pushing Legislation to Restore Newborn Screening

In the midst of all drama and sports analysis of the Super Bowl of late, it seems fitting to speak of offense and defense.

As someone who has spent her fair share of time in legislators’ offices or testifying in front of legislative committees on behalf of our children and their health, I am thrilled to share with you a subtle but important shift as we approach the 2014 session. This year is different in one key way: We’re on offense.

Far too often in past legislative sessions, the MNAAP has been forced to play defense. We spent our resources battling proposals that were bad for our patients. From legisla-tion to prohibit physicians from asking about firearms in our patients’ homes to defeat-ing efforts to repeal the state’s minor consent laws that allow us to provide care to our young patients, the MNAAP has been at the Capitol working to defeat damaging bills. That is incredibly important work, but it often felt defeating to always be reacting to the dangerous agenda of others.

This year is different. With the start of the legislative session on Tuesday, February 25, we will be at the Capitol actively and proactively pushing our own legislation to protect our youngest patients. We’ll be focused on renewing our Newborn Screening Program.

This issue of Minnesota Pediatrician has been mailed to non-members as well as members of MNAAP. If you don’t receive this newsletter on a regular basis, you are likely not a member. Please consider joining! Turn to page 13 for more

Don’t Miss Out on Membership! Join Today!

Continued on page 8

MNAAP has 960 members


Sat, Feb. 8 Harold Katkov Tutorial in Pediatric Cardiovascular Medicine for the Primary Practitioner Hosted by Children’s Hospitals and Clinics of Minnesota

Tues, Feb .11 Noon Webinar: ICD-10-CM Coding Part 1 Presented by Jeff Linzer, Sr, MD, FAAP, FACEP

Fri, Feb. 28 Topics in Pediatric Emergency Medicine Hosted by Children’s Hospitals and Clinics of Minnesota

Fri, April 25 Pediatric DermatologyThe Commons Hotel, Minneapolis Hosted by U of M

Thurs, May 1 - Sun, May 4 Child & Adolescent Psychiatry Practical Review for Primary Care and Mental Health Providers Grand Superior Lodge, Two Harbors Hosted by St. Cloud Hospital

Mon, May 5 - Wed, May 7 Moving Forward in the Treatment of Pediatric Neurological Disorders Minneapolis Convention Center Hosted by Gillette Children’s Specialty Healthcare

Thurs, May 8 Spring Pediatric Update Bullying Risks and Response: A Primary Care Approach Hosted by Children’s Hospitals and Clinics of Minnesota

Thurs, May 29 - Fri, May 30 Topics and Advances in Pediatrics Courtyard by Marriott Mpls Hosted by U of M

Sat, June 7 - Fri, June 13 Pain Master Class Hosted by Children’s Hospitals and Clinics of Minnesota

Friday June 13Hot Topics in Pediatrics Conference & Annual Meeting

• Practical Approaches to Managing and Preventing Pediatric Obesity

• Eliminating Health Disparities

• MNAAP Annual Dinner The Hilton, Bloomington Hosted by MNAAP

Sun, Aug 17 - Fri, Aug 22 Pediatric Cardiology 2014 Review Course The Ritz-Carlton, Calif Hosted by Mayo Clinic

Thurs, Sept. 11 - Sat, Sept. 13NPHTI Pediatric Clinical Hypnosis Oak Ridge Hotel and Conference Center, Chaska Hosted by U of M

Thurs, Sept. 18 - Fri, Sept. 19 Practical Pediatrics for the Primary Care Physician Hosted by Children’s Hospitals and Clinics of Minnesota Mid

Mon, Sept. 29 - Tues, Sept. 30 Pediatric Days 2014 Chicago, IL Hosted by Mayo Clinic

Minnesota

PediatricianThe official publication of MNAAP

1043 Grand Ave. #544 St. Paul, MN 55105 Phone: 651-402-2056 Fax: 651-699-7798 www.mnaap.org

Editor Melissa DeBilzan [email protected]

Editorial CommitteeAnne Edwards, MD; Lori DeFrance, MD; Julia Joseph- DiCaprio, MD; Robert Jacob-son, MD; Elsa Keeler, MD; Wade Larson, MD; Rachel Lynch, MD; Mike Severson, MD; Emily Borman-Shoap, MD

Statement of PurposeMinnesota Pediatrician is dedicated to providing balanced, accurate and newsworthy information to Minnesota pediatricians about current issues in pediatrics and the actions of the Minnesota Chapter of the American Acad-emy of Pediatrics. Articles and notices cover organizational, economic, political, legisla-tive, social, and other medical activities as they relate to the specialty of pediatrics. The content is written to challenge, motivate, and assist pediatricians in communicating with parents, colleagues, regulatory agencies, and the public.

AdvertisingAll products and/or services to be considered for advertising must be related to pediatrics. The Minnesota Chapter does not accept advertising or spon-sorship dollars from pharma-ceutical companies. The Chapter reserves the right to reject or cancel any advertising.

To inquire about advertising, email [email protected]

PresidentRobert Jacobson, MD

President-ElectSusan Berry, MD

Secretary/TreasurerAbe Jacob, MD

Past-PresidentMarilyn Peitso, MD

Board MembersEmily Chapman, MDVijay Chawla, MDLori DeFrance, MDJulia Joseph-Di Caprio, MDDamon Dixon, MDRon Furnival, MDMalinda Harris, MDMichelle Hulse, MDAnupam Kharbanda, MD, MScPhillip Kibort, MD, MBA Andrew Kiragu, MD Kelsey Klaas, MDJessica Larson, MDWade Larson, MDManu Madhok, MDAngela Mattke, MDLawrence Morrissey, MDJuliana O’Laughlin, MDHampton Rich, MDKatie Satrom, MDScott Schwantes, MDSarah Jane Schwarzenberg, MDEmily Borman-Shoap, MD L. Read Sulik, MDStephen Sundberg, MD

Executive DirectorKatherine Cairns, MPH, [email protected]

Director of CommunicationsMelissa DeBilzan [email protected]

LobbyistEric Dick [email protected] To register or for more information, visit

www.mnaap.org/calendar.htm

Upcoming Local CME Opportunities


TENTATIVE SCHEDULE:1:00 - 2:30 p.m. Welcome and “Advocacy 101”

MNAAP Pediatric Priorities

Group discussions with legislators

2:30 - 4:00 p.m. 1-on-1 meetings with individual legislators

Committee meeting attendance, pending space

5:00 - 6:00 p.m. Legislative Meetings Debriefing and Appetizers at Axel’s Bonfire Grill at 850 Grand Ave. in St. Paul (optional)

MARCH

262 0 1 4

PEDIATRICIANS’ DAY AT THE CAPITOL

FIND OUT MORE AND REGISTER ONLINE AT:W W W . M N A A P . O R G / PEDSDAYATTHECAPITOL.HTM

LAST YEAR MORE THAN 100 PEDIATRICIANS AND PEDIATRIC RESIDENTS GATHERED AT THE CAPITOL!

DON'T MISS YOUR OPPORTUNITY TO LEARN MORE ABOUT AND PARTICIPATE IN THE LEGISLATIVE PROCESS!

LOCATION:MN STATE CAPITOL75 Rev. Dr. Martin Luther King Jr. Blvd. Saint Paul, MN 55155

8:00 a.m. - 12:00 p.m. Practical Approaches for Managing and Preventing Pediatric ObesityCo-hosted by the Minnesota Pediatric Obesity Consortium

Discuss evidence-based practices for managing and preventing pediatric obesity with a special focus on co-morbidities and underserved populations Presentations take a closer look at food insecurity; fatty liver disease; dyslipidemia and multi-cultural approaches to discussing healthy weight with Latino, Native American, Somali and Hmong families.

2014 HOT TOPICS IN PEDIATRICS CONFERENCEWHEN: Friday, June 13, 2014

WHERE: Hilton Hotel, St. Paul Airport-MOA

Visit www.mnaap.org for details and registration.Register by Tuesday, April 15 for early-bird rates!

Speakers include: Renée Jenkins, MD, past president of AAP and Professor of Pediatrics at Howard University College of Medicine; Diana Cutts, MD, assistant chief of pediatrics at HCMC; Nissa Erickson, MD, pediatric gastroenterologist at Minnesota Gastroenterology, P.A., Julia Steinberger, MD, pediatric cardiologist at University of Minnesota Amplatz Children’s Hospital; Muna Sunni, MD, FAAP, assistant professor at the University of Minnesota in the division of pediatric endocrinology; Julie Boman, MD, FAAP, pediatrician at Children’s Hospitals and Clinics; Damon Dixon, pediatric cardiology fellow at University of Minnesota Amplatz Children’s Hospital. Additional speakers to be announced soon.

1:00 p.m. - 5:00 p.m Eliminating Health Disparities: Pediatric Challenges and Successes Minnesota is a leader in children’s health, but has one of the largest gaps in health disparities in the country. This session will focus on persistent disparities in health outcomes for minority children in Minnesota, including rates of immunization, obesity and infant mortality. Gain practical resources you can share with families in order to get them connected to the care and services they need.

6:00 p.m. - 9:00 p.m. MNAAP Annual Meeting and Dinner: Breaking the Impact of Poverty on Child Health More than 11 percent of all Minnesota children live in poverty. What can individual pediatricians do about this statistic and its impact on child health? Following our keynote by Renée Jenkins, MD, past president of AAP, hear a brief overview of newborn screening and other hot topics. This is a great opportunity to re-connect with colleagues and learn more from those who are leading the way to protect and enhance the health of Minnesota’s children.

__________________________________________________________________________________________________first Name last Name designation

__________________________________________________________________________________________________Phone email

__________________________________________________________________________________________________organization Name aaP id number

Please select the sessions you plan to attend:

QUESTIONS? CONTACT Melissa deBilzan 651-338-1823 [email protected]

ExhIbITINg OPPOrTUNITIES

Community non-profits and organizations that provide valuable pediatric tools and resources are encouraged to exhibit. email [email protected] for details.

DON’T MISS OUT! rEgISTEr NOW!2014 hOT TOPICS IN PEDIATrICS CONFErENCEfriday, June 13, 2014

register below or online at www.mnaap.org

Practical approaches for Managing and Preventing Pediatric obesity

eliminating health disparities: Pediatric Challenges and successes

MNaaP annual Meeting and dinner: Breaking the impact of Poverty on Child health Keynote: renée Jenkins, MD, FAAP, past president of AAP

Early bird rate After April 15

$159 $179 half day - includes 1 session plus 1 ticket to MNaaP’s annual meeting/dinner

$199 $209 fUll day - includes 2 sessions plus 1 ticket to MNaaP’s annual meeting/dinner

$49 $59 aNNUal MeeTiNG/diNNer oNly - includes 1 ticket to MNaaP’s annual meeting and dinner

MAIL COMPLETED FOrMS WITh PAYMENT TO:MNaaP1043 Grand ave. #544st. Paul, MN 55105 Or Fax to: 651-699-7798

Total Enclosed: $ _______________ MasterCard Visa Check (payable to MNaaP)

__________________________________________________________________________________________________address City state Zip Phone

__________________________________________________________________________________________________Credit Card Number exp. date CsV Code Billing Zip

__________________________________________________________________________________________________Print Name as it appears on Card

I cannot attend MNAAP’s annual meeting/dinner. Please donate my meal ticket to a resident/medical student.


What were the top ten events for our chap-ter in 2013? What would such a list look like, and what would we learn from it?

I ended up making such a list to help with our year-end reporting. At the end of 2013, our chapter submitted its annual chapter report for the national organiza-

tion. The report details MNAAP’s accomplishments for the year. It’s a Herculean task of cleaning out the stables of the year gone by and trotting out accomplishments for a national audience. We ask the leaders of our workgroups and committees to participate in the reporting as well.

Each of us on the board would probably list different things. Perhaps many items would overlap but the order would vary greatly. My own top ten list includes the following:

1. Updated School and Daycare Immunization Rules. The successful adoption of the updated Minnesota School and Daycare Immunization Rules in August had been a long time coming. Katherine Cairns, our executive director, and I began meeting as representatives of the chapter in 2012 with the immunization rules task force that the state assembled. Dr. Dawn Martin, chair of the MNAAP Immuni-zation work group, kept members informed of the updates at meetings and in the newsletter. We finalized that work in the spring of 2013 and waited with apprehension for the period of public notification and comment. In a tense ad-

ministrative hear-ing this summer, I spoke on behalf of our chapter in support for the proposed rules, which included new vaccine requirements for Rotavirus, Hepa-titis B, Hepatitis A, Tdap, Vari-

cella, and Meningococcus. Our efforts paid off when the administrative judge ruled in favor of MDH, allowing the rules to become effective in September of 2014.

More info at www.mnaap.org/immunizations.htm

2. Pediatricians’ Day at the Capitol. This well-attended event involved more than 100 pediatricians meeting with legislators and successfully brought both of our state’s pediatric residencies together to participate in this show of legislative advocacy. The enthusiasm of the pediatricians-in-training was energizing and carried us through a rocky legislative season that saw the tabling of the anti-bullying

bill we pushed as well as the tabling of our efforts to stay the destruction of the newborn screening test data along with the blood spots themselves. The MNAAP’s efforts at the Capitol in regards to tobacco, however, were hugely successful as the MNAAP and our coalition partners advocated for – and won – a historic increase in the tobacco tax, a change that will result in far fewer adoles-cents smoking.

More info at www.mnaap.org/pedsdayatthecapitol.htm

3. Investments in Health and Education. We advocated for the successful approval of the state health budget with its support for pediatric and adolescent mental health as well as the approval of the state’s investment in early child-hood education and the critical congenital heart disease testing requirement.

4. Successful Education Programs. Our Hot Topics in Pediatrics Con-ference, held the day of our annual meeting, suc-cessfully brought together nearly 150 attendees for our program-ming on obesity and motivational interviewing.

5. Dynamic Annual Dinner. Those in attendance won’t soon forget the 2013 annual dinner where our keynote speaker, Dr. Piero Rinaldo, spoke so passionately for the return of Minnesota Newborn Screening to where it was just several years ago: the best in the country and the world with so much promise for the future.

More info at www.mnaap.org/annualmeeting2013.html

6. New and Improved Website. We rolled out our new web presence in 2013. While it is easy to take a web site’s appearances and functionality for granted, we know that our organization depends on the ease of communication. Our web pages are central to our organization’s ongoing conversation across the state.

More info at www.mnaap.org/

7. Collecting Member Feedback. Every year we conduct an all-member survey. It is a big event for us because it provides our members a chance to weigh in on a variety of

Word from the President: Robert M. Jacobson, MD, FAAPA look back at MNAAP’s highlights in 2013

Robert Jacobson, MD, FAAP was among many testifying in support of new immuni-zation rules.

Great turnout at last year’s Pediatricians’ Day at the Capitol.

About 150 people attended Hot Topics in Pediatrics conference and annual dinner.

7MNAAP -- Dedicated to the health of all children. Visit us at www.mnaap.orgContinued on page 6...

Robert M. Jacobson, MD, FAAP MNAAP [email protected]

New Immunization Laws for School, Child Care, and Early Childhood Programs

On Sept. 1, 2014, changes to the Minnesota’s Immuni-zation Law will take effect for schools, child care, and early childhood programs. The changes were made to be more closely aligned with the current Advisory Committee on Immunization Practices (ACIP) recom-mendations. Medical and conscientious exemptions are still allowed under the law.

New vaccines requirements include:

• Hepatitis B – For all children over 2 months old enrolled or enrolling in child care or an early child-hood program.

• Hepatitis A - For all children over 12 months old enrolled or enrolling in child care or an early child-hood program.

• Tdap - For all students entering seventh grade. Students in eighth through 12th grade must show documentation if the school requests it. This re-places the Td immunization requirement.

• Meningitis (meningococcal) - For all students entering seventh grade. Students entering eighth through 12th grade must show documentation if the school requests it.

For more detail on all the changes to the law, visit the MDH website at www.health.state.mn.us/divs/idepc/ immunize/immrule/index.html.

topics in a relatively easy format. We worked hard to make that survey user friendly. In the months to come, the survey responders will see we’ve taken their responses seriously and will direct our work going forward.

View results at svy.mk/1cc1RKk

8. Maintenance of Certification Programs. Last year we saw our first enrollees in all of our MOC 4 programs. We have three underway—in pediatric obesity, medical homes, and immunizations. It’s a concerted effort that our board of directors took so seriously as to assign the effort to each of our work groups to make these MOC 4 experiences hap-pen.

We also are seeking permission—new this year—to begin offering MOC 2 credit. We are in the process of submitting a grant that would support our development of an MOC 2 experience regarding HPV vaccine communication.

More info at www.mnaap.org/moc4.htm

9. Vaccine Hesitancy Training. The previous year our chapter obtained a grant to teach pediatricians the CASE approach to vaccine hesitancy, and we brought that teaching this year to Saint Cloud’s CentraCare CME pro-gramming as well as to the University of Minne-sota’s pediatric residency program. In addition, we published the technique in Minnesota Medicine as well.

More info at www.mnaap.org/immunizationsed.htm

10. Increased membership. We held a number of events to improve membership in the AAP at the chapter level, including a special mailing to all pediatric specialists across the state. That along with our concerted efforts to support our medical schools’ pediatric interest groups garnered us new members across the spectrum of pediatric professionals.

This year we topped 1,000 members—our best year yet.

That’s my ten. What did I learn from making that list? First, our chapter’s success completely depends on pediatri-cians coming together to volunteer their time, interest, and wisdom. Second, our chapter’s resources including its staff consultants, if not especially them, can turn ideas into real-ity. And, third, if that’s what we accomplished last year, just imagine what we can do in the years to come!

Discussing the CASE method during vaccine hesitancy training.

MNAAP Board Meeting in 2013


Newborn Screening, continued from page 1...

This life-saving program has been subject to dangerous changes since a 2011 Minnesota Supreme Court decision and subsequent legislative action.

Our message to legislators is a simple one, and can be summed up simply:

1. RESTORE. Minnesota’s newborns are being harmed by recent changes to newborn screening. Minnesota is the only state that destroys newborn screening data soon after birth, putting babies and families at risk.

2. SAVE. Storage of blood spots and data assure proper diagnosis and timely follow up for critically ill children. Ad-ditionally, storage supports quality improvement and the de-velopment of new tests that lead to life-saving treatments.

3. LEAD. If given the opportunity, Minnesota’s newborn screening program can once again serve as a national leader in saving as many lives as possible from death, dis-ability and impairment.

At the risk of mixing my sports metaphors, we’ll need a “full court press” in 2014 to be successful. But to win, pediatri-cians have to be part of the game plan. MNAAP members need to pick up the phone or craft an email to your elected official to explain how this program saves lives. While visit-ing with legislators can be intimidating, no one understands this issue better than us. Stay tuned for opportunities to lend your support to our shared effort on behalf of our patients.

We’re in a new position at the Capitol this year. As advo-cates for children, defeat is not an option -- we have a very real opportunity to reverse the damage already done.

I, for one, think it feels good to have the ball in our hands for a change.

Newborn Screening by the Numbers

5,000 newborns have screened positive since the program’s beginning and have been saved from death or permanent disability

134 newborns screened positive in 2013 and were saved from death or permanent disability

71 days until a negative blood spot is destroyed; not enough time to complete testing or follow up in some cases

2 years until a positive blood spot and all test results are destroyed; they are unavailable for future analysis or reference

2 newborns are expected to test positive for SCID in 2014

unknown number of newborns were missed for SCID during 2010-2013 because the test was delayed due to unavailability of blood spots...which must be destroyed after 71 days.

The destruction of 1 million blood spots and other recent set-backs to Minnesota’s newborn screening program are cause for alarm among Minnesota’s pediatricians.

Stay InformedTo learn more about MNAAP’s efforts in this area, email [email protected] or visit www.mnaap.org/ newbornscreening.html for the latest updates and fact sheets.

Get InvolvedMNAAP is working with Rep. Kim Norton and Sen. John Marty to draft legislation to restore Minnesota’s newborn program. Watch for opportunities in the com-ing weeks to view the bill and express your support. Email [email protected] to discuss specific ways to lend your support.


Minnesota prides itself on being one of the finest places to raise a family and has frequently been ranked as one of the healthiest states in the country. In 2004, the Annie E. Casey Foundation ranked Minnesota first overall in the well-being of its children using 16 measures of child well-being in the four major domains of economics, education, health, and family.

But in its 2013 report, Minnesota had slipped to fourth over-all and 15th in the health of children category. This decline in our state ranking is resulted in part to persistent dispari-ties in health outcomes for minority children in Minnesota. Infant mortality and immunizations are two health outcomes that epitomize these disparities.

The Infant Mortality Rate or IMR is considered by many as a pre-eminent marker of the overall health of a community. Minnesota’s IMR is 4.61 infant deaths per 1,000 live births--better than the national average of 6.39. But this is largely the result of Minnesota’s IMR for non-Hispanic, white-infants, which is at is 4.14. For African Amerian infants, Minnesota is worse than the national average--at 7.44. Minnesota is similarly worse than the national average for American Indian children--at 8.6.

Minnesota’s overall high ranking also holds true for immu-nization. Overall, Minnesota ranked seventh in the nation among children fully immunized at 19-35 months old. But stark differences in Minnesota’s immunization rates emerge based on a child’s race and ethnicity. The percent of children fully immunized was 85 percent for white, non-His-panic toddlers but only 73 percent for American Indians, 66 percent for Asian/Pacific Islanders, 65 percent for Hispan-ics, and 63 percent for non-Hispanic African Americans.

These are just two of the measures. Others similarly demonstrate the disparities in health care across the state

varying by race and ethnicity.

Minnesota pediatricians take pride in the access and quality of care we deliver to our children and their families. How-ever, there is a danger when we, as Minnesotans, consis-tently see the overall health of our children held up as an example to the rest of the nation. We must celebrate the success but realize that the gradual slippage of our overall state as well as persistent disparities indicate that there is still work to be done.

First, we must continue to be cognizant of persistent disparities and translate that knowledge into action. This includes the ongoing promotion of “Back to Sleep,” smoking cessation, and breast-feeding in our practices as primary prevention strategies to reduce infant deaths. We know that the adoption of these strategies are not evenly utilized by communities of color due to access, poverty, non-financial barriers, and cultural differences.

With regard to immunizations, we must remain vigilant in the promotion of the efficacy of vaccines for children. We must also encourage participation in the Vaccines for Children program as well as Medicaid, MinnesotaCare, and MNSure. It will be through such efforts that we will be able to achieve the equity we as pediatricians strongly embrace.

Persistent Disparities Causing Health of Minnesota Children to Slip By Charles N. Oberg, MD, FAAP, Program Director of Maternal and Child Health at the University of Minnesota’s School of Public Health and pediatrician at Hennepin County Medical Center

References

1 Kids Count 2013 Data Book-State trends in child well-being. Annie E. Casey Foundation, Baltimore, Maryland, 2013

2 The State of America’s Children Handbook-2012, The Children’s Defense Fund, Washington DC, p. 27, Table 15

3 Disparities in Infant Mortality, Minnesota Department of Health, January 2009

4 Immunization &Health Disparities, Minnesota Department of Health

Be sure to register for Eliminating Health Disparities

Friday, June 13. Turn to pages 4-5 for details and registration.

“This decline in our state ranking is resulted in part to persistent disparities in health outcomes for minority children in Minnesota.”


For about 30 years, the AAP has rec-ognized the importance of media in the lives of children and teens, but obviously the amount, complexity, and challenges of the various types of media continue to evolve. We all live in a world saturated with and surrounded by media, and even as I write this article, creative minds are at work on new products and programs!

More than 75 percent of teens have cell phones; some send more than 100 text messages daily, and millions spend hours on Facebook.

The impact of media on children and adolescents is a major focus of the AAP into the future and the Board has committed time, money, and energy to the ongoing task of educating pediatricians, parents, teens, and children about media: How do we recognize and mitigate the potential harm? How do we embrace positive and pro-social media? In this spirit, the executive committee of the Council on Communications and Media (COCM) revised and published the policy statement now titled “Children, Adolescents, and Media” last fall. There are several other COCM policy state-ments and reports relevant to the impact of media on our patients and families, including the recent “Media Use by Children Younger than 2 Years” and “The Impact of Social

Media on Children, Adolescents, and Families.”

Although media continue to evolve, so much remains the same. Many children and teens have few rules about media use, but still spend many hours daily with media -- and television is still predominant. In 2013, children ages 8-11 years averaged 8 hours of daily screen time, while older children spent more than 11 hours daily with a variety of media. The amount of time spent with media concerns pediatricians and parents because during those hours children and teens are not socializing with family or friends, reading books, playing active games, enjoying creative pursuits, or just day-dreaming (still a valuable commodity!). Although TV captures the most hours, video games, social media, and other platforms are gaining in popularity.

Research confirms that media use for some youngsters is associated with negative outcomes, notably sleep disturbances, aggressive or antisocial behavior, obesity, and poor school performance. At the same time, positive and pro-social media has been shown to model empathy, tolerance, and a whole range of valuable interpersonal skills and can also teach valuable school readiness skills. Media can transport children and teens (and their parents!) to new places and open doors to learning and creativity. Social media allows teens to communicate and connect

Screen Time in Moderation: Advising a Healthy Media DietBy Marjorie Hogan, MD, FAAP, pediatrician at HCMC and executive member of AAP’s national Council on Communications and Media


with friends and importantly, explore who they are. Media are not intrinsically good or bad -- what matters is how we choose and use programs and activities.

The new “Children, Adolescents, and Media” policy state-ment provides some new ideas and tools for parents and pediatricians as we navigate the ever-changing media world.

We encourage implementation of a family media use plan in every home -- ideally every member of the family can participate in creating this plan. This encourages families to think about a healthy media diet -- analogous to the readily-understood healthy food diet. We should make, as a family, wise media choices -- age-appropriate programs, games, and platforms -- and not allow media to be random event in the home.

Parents should also keep televisions and Internet connec-tions out of kids’ bedrooms and centralize media platforms, whenever possible. This allows parents to watch and moni-tor media use with children -- another important tenet of the family media use plan. Co-viewing media is a golden op-portunity for parents to teach about their own values and be certain children can comprehend and deconstruct images and messages in media. Our kids often are far more media savvy than we are -- media education encourages parents to keep up to date on current innovations. Parents should also consider their own media habits -- limiting children to less than 1-2 hours daily while we watch TV for hours or use cell phones at the table is confusing at best!

We advise limiting children and teen to less than 1-2 hours of entertainment media exposure daily -- legitimate media use for homework not included! Another recommendation of the family media use plan is to implement and enforce a media curfew -- a clear time when everyone’s devices are docked for the night (especially important consid-ering the impact of late night media use on a good night’s sleep).

Importantly, for good evidence-based rea-sons, we encourage no screen exposure for little ones under the age of 2 years. There is no evidence that media exposure is beneficial for these very young children and there is growing reason for concern about the potential adverse effects on lan-guage and other development. Parents beware: now infant seats, potty chairs, and other products are coming equipped with an iPad holder to keep baby or tod-dler transfixed. Our littlest children need

real-life inter-action with loving adults, not more screen time!

Parents can be advocates, whether by encouraging schools and communities to teach me-dia education courses or by pressur-ing the media industry to create positive and pro-social products and programs for children and adolescents.

Media are never going away and will only become more per-vasive and important in our lives. This policy statement hopes to encourage media educated parents and children to make wise choices, mitigate the potential harm, and allow all of us to recognize and embrace the positives media can offer.

Fisher-Price sells a newborn to toddler seat equipped with an iPad holder.

We’ve redefined “long-term relationship.”

With the help of dedicated partners like you, we’ve been delivering compassionate, leading- edge care for children in Minnesota for more than 100 years.

To consult with us or refer a patient, visit uofmchildrenshospital.org/mnaap or call 888-KIDS-UMN (888-543-7866).

Minnesota’s most experienced academic children’s hospital

�

Read the policy statement at: http://pediatrics.aappublications.org/content/132/5/958

More information for parents on creating a family media use plan is available on HealthyChildren.org.


Member Profile: Janice Rourk, MD, FAAP Pediatrician at Grand Itasca Clinic & Hospital

What’s your background?

I remember making the decision to go into medi-cine when I was 11. I spent most of that summer in the ICU waiting room hop-ing that my father would recover from a cerebel-lar hemangioblastoma. I realized then the power that a physician has to change not only the life of the patient, but the lives of everyone who loves that patient.

My dad lived another 5 years and I was grateful for the additional time I had with him. I didn't go to medical school right away; I got married at 19, became a nurse and had two kids. When I found that the desire to pursue medicine wouldn't go away, I applied to and was accepted into the University of Michigan Medical school. My first year pathol-ogy professor promised that we would be able to indulge our passion for disease. I did my residency at U of M as well. I had grown up in Michigan and had a lot of family support there, so it was a great fit. When I graduated from residency my husband and I wrote out a list of our dream requirements for a first job. My attendings were tearing their hair out for fear I was too picky and would never be hired, but the folks at Grand Itasca called and said they had just what I wanted. I was the first resident in my year to land a job.

What are some of the biggest challenges you face as a rural practitioner?

I was the first pediatrician in Grand Rapids, MN. I devel-oped a complicated practice early on because I was viewed as a specialist and everyone who had a child with chronic disease came to see what I was made of. When you live in a rural area, it's not that you don't have access to tertiary care, it's just that you are asking a lot of your patients in terms of time, money, and effort, to obtain it. That means you need to be certain you need it before you send your patient several hours down the road to receive care. The first year I was in practice, I called the U of M helpline so many times the operators recognized my voice on the phone! Eventually, I developed relationships with special-ists in Minnesota who would help me to prepare my patients as fully as possible before we invested in a trip to visit them.

I have been on the hospital board for the last 3 years and the decisions we make will affect health care in our commu-nity for years to come. This is a privilege, but sometimes a heavy responsibility.

What are some of the biggest advantages of being a rural practitioner?

Everyone is famous in a small town. My husband nearly drove off the road the first time he saw my face on a billboard. I've done local TV shows, radio, written newspaper articles, talked to various local groups and helped run an asthma camp for the past 10 years. I never get tired of walking into a room and hear-ing the stage whisper of some small child proudly exclaim-ing, "That's my doctor!"

Grand Rapids is a resort town, which makes it easier to balance my love of the outdoors with the long hours of a pediatrician. During the nice weather I bike to work. I've tried cross country skiing the 4 miles to work a few times in the winter, but that takes a lot more planning. The lake is in my backyard. I can remotely access our electronic medical record, so during the long daylight hours in the summer, I can go out for a run, swim or a spin on the wakeboard and do my charts after dark.

What do you enjoy most about being a pediatrician?

Kids are fun. They cheer me up. No two days are ever alike. I enjoy being able to solve a problem and watch-ing the relief of the parents as they see their child getting better. There are few things as satisfying as resuscitating a newborn or reducing a nursemaid's elbow. In both cases the fix is quick and you can see the relief during a single visit. I'm learning to enjoy the longer-term problems as well because of the huge impact they have on the child's life.

If you weren't a pediatrician, what would you be and why?

My daughter taught English in Thailand and my nephew was in the peace corps in Burkina Faso. I was able to visit both of them and I was fascinated on both trips. The oppor-tunity to be able to help others while doing both of those things appeals to me, so I might try to find a fit in the peace corps.

Any hobbies/interests outside of medicine?

I've been married for over 30 years. My son is starting his own business training athletes. He took me on as a per-sonal challenge, and with his help last summer I was able to complete our local timber man triathlon: a 1-mile swim, 24-mile bike, and 6-mile run. I learned all about muscle cramps, but finished in the time allotted for the race! In Feb-ruary 2014, I plan to skate ski my 5th Birkie, a 50 kilometer ski race. I'm also starting to develop a fondness for Oregon as my daughter and her husband live there.


Chapter dues are $130/year

For more information or to join, call 651-402-2056 or visit www.mnaap.org/statememberinfo.htm


CHIPRA Center of Excellence Pediatric Quality Measure Project Update

MNAAP Members, Let’s Hear Your Award Nominations!

Distinguished Service Award

Recognizes a pediatrician for his or her outstanding efforts that contribute to the improvement of child health care.

Child Advocacy Award

In addition, MNAAP chooses an individual from the community who goes above and beyond his or her everyday routine to advocate for the health and welfare of children in Minnesota.

All nominations due May 1, 2014. Visit www.mnaap.org for nomination forms and details.

Back by Popular Demand! Abstract Competition at Annual Meeting

Once again this year, MNAAP will hold a resident and medical student abstract and poster competition at the annual meeting on Friday, June 13 at the Hilton MOA.

The goal of the competition is to foster community among pediatric trainees across the state.

Abstracts should number no more than 450 words and must be submitted electronically. Authors will be judged by Minnesota pediatricians; winners will receive a prize and their projects will be published in Minnesota Medicine.

Details at www.mnaap.org/annualmeeting.htm

AFFILIATED COMMUNITY MEDICAL CENTERS, WILLMAR

ALLINA MEDICAL CLINIC COON RAPIDS

ALLINA MEDICAL CLINIC HASTINGS

FAIRVIEW CLINICS – BLOOMINGTON

CENTRACARE CLINIC-WOMEN CHILDRENS

CHILDRENS HOSPITALS & CLINICS PRIMARY CARE MINNEAPOLIS

CHILDRENS HOSPITALS & CLINICS PRIMARY CARE ST. PAUL

EAST SIDE FAMILY CLINIC

ESSENTIA HEALTH DULUTH CLINIC

ESSENTIA HEALTH HIBBING CLINIC

ESSENTIA HEALTH - BRAINERD CLINIC

FRIDLEY CHILD & TEEN MED CENTER

FAIRVIEW MAPLE GROVE MEDICAL CENTER

FAIRVIEW RIDGES HOSPITAL

HEALTHPARTNERS ST. PAUL

HENNEPIN FACULTY ASSOCIATES/ HCMC

LAKE REGION HEALTHCARE

MANKATO CLINIC

MAYO CLINIC

METRO PEDIATRICS

NATIVE AMERICAN COMMUNITY CLINIC

NORTH POINT HEALTH AND WELLNESS CENTER

OLMSTED MEDICAL GROUP

OWATONNA CLINIC - MAYO HEALTH SYSTEM

PARK NICOLLET CLINIC BROOKDALE

PARK NICOLLET CLINIC MINNEAPOLIS

PARK NICOLLET CLINIC ST. LOUIS PARK

PEDIATRIC & YOUNG ADULT MEDICINE

SANFORD SOUTHWEST CLINIC

SOUTH LAKE PEDIATRICS WEST

UMP BROADWAY FAMILY MEDICINE

UNIVERSITY OF MINNESOTA AMPLATZ CHILDREN’S HOSPITAL

Thank you to the following clinics and hospitals for their participation in this project!

Over 400 parents in Minnesota have provided their input, and now it is your turn. MNAAP has sent out over $7200 to date to health care providers who have completed surveys on their patient’s social complexity. The national Center of Excellence is hoping to better understand sig-nificant social stressors which may interfere with a fam-ily’s ability to address a chronic medical condition. Two additional projects included written parent consent for abstraction of records for Minnesota children with chronic conditions are also underway.

Online CME produced as a part of this project is avail-

able for any physician. Topics include: “Pediatric Qual-ity Measure Development,” “Pediatric Preventive Care: Adolescent Mental Health, Depression Screening” and “Minnesota Adverse Childhood Experiences (ACE) and social complexity.” CME information at http://www.mnaap.org/pediatricqualityed.html Pediatrician partici-pants in this project may also participate in the Medical Home MOC4 module without charge. MOC4 information at www.mnaap.org/healthcarehomemoc4.html

Contact [email protected] if you have additional questions about survey payment, the CME or MOC4 opportunity.


Employment Opportunities

Pediatrician, Willmar

Affiliated Community Medical Centers

Developmental

Behavioral Pediatrician Minneapolis

HealthPartners

BE/BC Pediatricians, Southwest Metro

Lakeview Clinic

For details on these opportunities, visit www.mnaap.org

2013 Member Survey Results

More than 100 members completed the chapter's annual membership survey. Your responses and feedback are appreciated and have been shared with MNAAP board members to shape future activities and member benefits. Thanks for participating!

Some key insights:

• 78 percent of respondents are currently in practice; the remainder are in training (14 percent) or retired (7 percent).

• About half of respondents work in an urban practice as opposed to suburban (42 percent) or rural (8 percent).

• 85 percent of respondents say they are concerned about recent changes to Min-nesota's newborn screening program.

• 47 percent of respondents use social media for professional use on a regular basis.

• The top five topics members want more information about are pediatric obesity, child poverty and disparities, adolescent medicine, developmental and behav-ioral pediatrics and pediatric quality measures.

• The newsletter was cited as the most useful member benefit, followed by all-member emails, a newly redesigned website, opportunities to support chapter advocacy, discounted rates for continuing medical education programs, opportu-nities to participate in chapter work groups, and opportunities to apply for grants with chapter help.

• 86 percent of members would recommend MNAAP membership to a colleague.

View a summary of all results at http://svy.mk/1cc1RKk

Work group chair Amy Burt, MD leads the bimonthly work group conference calls that are coordinating several projects:

• Two pediatricians have completed the Medical Home/HCH MOC4 module and earned ABP points in 2013 with several others in process. The work group serves as the virtual learning collaborative for MOC4 participants working on this module. There is still time to sign up for the MOC4 modules and complete it in 2014.

• A grant from the Minnesota Department of Health for a medical home learning collaborative was funded to support clinics, hospitals and a health plan work on transitions in sites of care. Thank you to the leadership of Dr. Abe Jacob (University of Minnesota Amplatz Children’s Hospital), Dr. Robert Payne (Children’s Hospital and Clinics of Minneso

ta), Dr. Randall Flick (Mayo Clinic Children’s Cen-ter), Dr. Mary Braddock(Gillette Children’s Specialty Healthcare),and Dr. Amy Burt (Medica Health Plan) for your work on this project. The project will be seeking primary care clinics who admit to these hospitals or serve children/teens with Medica cover-age to work on this project.

• Communication with the Minnesota Department of Human Services regarding their plans to create a Behavioral Health Home continues. MNAAP has expressed concerns about a separate Behavioral Health Home for children and teens that is discon-nected from their primary care clinic.

• Contact [email protected] if you would like information about upcoming work group confer-ence calls, the new learning collaborative project or Behavioral Health Homes.

MNAAP’s Health Care Home Project Updates

1043 Grand Avenue, #544 St. Paul, MN 55105

www.mnaap.org

Nonprofit Org. U.S. Postage

PAID

Twin Cities, MNPermit #3399

REGISTER NOW! | WEDNESDAY, MARCH 26, 2014

PEDIATRICIANS’ DAY AT THE CAPITOL

visit www.mnaap.org/pedsdayatthecapitol.htm

Thank you to MNAAP’s 2013-2014 sponsors

minnesota - mnaappediatric cardiology 2014 review course the ritz-carlton, calif thurs, sept. 11 -...

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